text:
Chapter 4 put forth a model (standard of care) for addressing psychosocial health needs. This chapter presents real-life illustrations of how this standard is already being implemented by some oncology practices and can be implemented by others, illustrating the feasibility of meeting the standard of care in situations with varying levels of resources.
Patients diagnosed with cancer are treated by many different types of clinicians across all phases of their cancer care. Some of these clinicians specialize in oncology; others, such as primary care physicians and general surgeons, have a patient population that is more heterogeneous with respect to diagnosis. The committee believes that all clinicians providing care for patients with cancer should attend to psychosocial health needs as part of their practice, but that oncologists can and should lead the way in addressing these needs. The committee therefore recommends that all providers of cancer care institute reliable processes to meet the standard of psychosocial health care. The National Cancer Institute (NCI), organizations setting standards for cancer care, and consumer advocacy organizations should promote these efforts by incorporating the recommended standard of care into their agendas, protocols, policies, and standards. NCI, the Centers for Medicare & Medicaid Services, and the Agency for Healthcare Research and Quality, individually or together, should conduct a program designed to demonstrate additional approaches to meeting the standard of care in different geographic areas and care settings, with more vulnerable populations, and in locations with varying resources.
Cancer treatment is delivered in a variety of settings, including, for example, the practices of medical oncologists; primary care providers;
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Implementing the Standard of Care
Chapter put forth a model (standard of care) for addressing psy-
chosocial health needs. This chapter presents real-life illustrations of how
this standard is already being implemented by some oncology practices and
can be implemented by others, illustrating the feasibility of meeting the
standard of care in situations with arying leels of resources.
Patients diagnosed with cancer are treated by many different types of
clinicians across all phases of their cancer care. Some of these clinicians
specialize in oncology; others, such as primary care physicians and gen-
eral surgeons, hae a patient population that is more heterogeneous with
respect to diagnosis. The committee beliees that all clinicians proiding
care for patients with cancer should attend to psychosocial health needs
as part of their practice, but that oncologists can and should lead the way
in addressing these needs. The committee therefore recommends that all
proiders of cancer care institute reliable processes to meet the standard of
psychosocial health care. The National Cancer Institute (NCI), organiza-
tions setting standards for cancer care, and consumer adocacy organiza-
tions should promote these efforts by incorporating the recommended
standard of care into their agendas, protocols, policies, and standards.
NCI, the Centers for Medicare & Medicaid Serices, and the Agency for
Healthcare Research and Quality, indiidually or together, should conduct
a program designed to demonstrate additional approaches to meeting the
standard of care in different geographic areas and care settings, with more
ulnerable populations, and in locations with arying resources.
Cancer treatment is delivered in a variety of settings, including, for
example, the practices of medical oncologists; primary care providers;
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surgeons; radiologists; and other specialists, such as hematologists and urol-
ogists (see Table 5-1).1 As stated in Chapter 4, the committee believes that
the delivery of psychosocial health services should occur from diagnosis
through all stages of the illness, and therefore, the standard for delivering
psychosocial health care articulated in Chapter 4 should guide the activities
of all clinicians delivering cancer care. Nonetheless, as adult and pediatric
oncologists are recognized specialists in the delivery of cancer care, they
should lead the way in implementing this standard of care. This chapter
focuses on how they can do so.
As of 2005, an estimated 12,000 oncologists practiced in the United
States in a variety of practice settings and arrangements, including teaching
hospitals (33 percent), group practices (46 percent), solo practices (9 per-
cent), and other arrangements. The majority of oncologists (56 percent)
worked with nurse practitioners and physician assistants who provided
patient education and counseling, pain and symptom management, follow-
up care for patients in remission, and other activities as part of patient care
(AAMC Center for Workforce Studies, 2007).
Oncology practices can take two general approaches to the delivery of
psychosocial health services in accordance with the model and standard for
care set forth in Chapter 4: (1) providing the needed services and interven-
tions directly themselves by offering collocated, integrated psychosocial
and biomedical health care, or (2) establishing effective linkages and coor-
dination of care with other providers.2 This chapter describes and provides
real-life examples of both approaches. Also described is a third approach, a
potential variation on the second that involves the use of remote providers
of psychosocial health services and can be employed in communities that
lack substantial psychosocial health care resources.
Many organizations blend these approaches, collocating some psy-
chosocial health services on site while coordinating and supplementing
1 The committee located no data describing how cancer care differs across these different
settings of care.
2 The committee recognizes that there are cases in which another party (e.g., another health
care provider treating a serious comorbid condition or a designated intermediary, such as a
disease management entity) also has responsibility for securing appropriate psychosocial health
services. However, the committee does not distinguish this as a separate approach to imple-
menting the model because coordination of care requires effective linkages among all parties
involved, and because at present and for the foreseeable future, the committee believes that the
dangers of too little attention to psychosocial problems outweigh the dangers of duplicative
attention to those problems.
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TABLE 5-1 Distribution of Adult Ambulatory Cancer Care Visits by Site
of Visit, Physician Specialty, and Clinic Type, United States, 2001–2002a
Visit Characteristic Number/Percentage
Annual number of visits (in 1,000s) 20,574
Site of visit (%)
Physician's office 89
Hospital outpatient department 11
Physician office visitsb (%)
Oncology 18
Primary care 32
General surgery 10
Specialty surgery 3
Dermatology 7
Urology 14
Other medical specialty 15
Hospital outpatient departmentc (%)
General medicine 78
Surgery 14
Other 8
aAdults were categorized as being aged 25 and older. Visits for non-melanoma skin cancer
were excluded.
bRadiologists were excluded from the sample of office-based physicians.
cClinics providing chemotherapy, radiotherapy, physical medicine, and rehabilitation were
excluded from the sample of hospital outpatient departments.
SOURCE: Analyses of the 2001 and 2002 National Ambulatory Medical Care Survey and the
National Hospital Ambulatory Medical Care Survey, as presented in IOM and NRC, 2006.
their services with the delivery of other services from off-site providers. As
discussed in Chapter 4, there is some evidence that collocated, integrated
services are more effective than arrangements with off-site providers in
ensuring that patients receive necessary care (Friedmann et al., 2000). In-
tegrating psychosocial health care into medical care settings also facilitates
patient follow-through on referrals, and allows for better communication
between individuals caring for patients and easy exchange of expertise
(Pincus, 2003). Studies of care collaboration also have shown that physi-
cal proximity facilitates collaboration among health care providers (IOM,
2004). However, when physical collocation of services is not possible, other
strategies for linking patients with needed services are required.
Approach 1: Collocated, Integrated Psychosocial
and Biomedical Health Care
In this approach, all components of the model described in Chapter 4
(identification of individuals with psychosocial health needs, care planning,
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linking of patients to providers of the needed services, support for patients
in illness self-management, coordination of psychosocial with biomedical
health care, and follow-up) take place at the same site where biomedical
health care is provided, as well as some psychosocial health services. The
physical plant and personnel requirements for implementing this approach
are substantial. Examples are found in clinics attached to academic medical
centers, but also in some leading community-based oncology practices.
The Rebecca and John Moores Cancer Center, University of California,
San Diego The Moores Cancer Center's Science of Caring Program pro-
vides comprehensive psychosocial health care integrated with biomedical
treatment for all patients with cancer seen in its outpatient clinic. At each
outpatient's initial visit, patient and family meet with a social worker who
provides printed information about the psychosocial health services offered
on site and an orientation to these services. At this first visit (and at regular
intervals thereafter), every patient also uses a laptop computer to complete
a simple touch-screen questionnaire—"How Can We Help You and Your
Family?"—developed by the center. The questionnaire consists of a list of
problems faced by patients with cancer. Patients are asked to identify the
extent to which each problem affects them and whether they would like
any help in dealing with it. Patients' responses (encrypted for privacy) are
quickly disseminated by e-mail to their health care team of physicians,
nurses, psychologists, and social workers. The data are also transmitted
automatically to a software program that allows for their analysis.
Patients are linked to needed psychosocial health services in multiple
ways. First, the computer-based screening program provides an automatic
link. For some problems, such as those involving transportation, the pro-
gram generates a printout of resources that is presented to patients by
administrative staff3 at the end of their appointment. For problems requir-
ing a more complex intervention, the automated screening tool generates
an e-mail to the team member with the expertise to address the problem.
Full-time, on-site social workers also provide case management and refer
patients to a wide variety of psychosocial health services available on site
(e.g., support groups, educational seminars, psychotherapy, stress manage-
ment) and from providers in the community.
Psychosocial care is coordinated with medical care by several means.
The collocation of psychosocial and biomedical services facilitates timely
3 Administrative staff also receive training and monthly updates on the value of the screen-
ing process.
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and direct face-to-face communication among providers. Additional com-
munication takes place during weekly team meetings and monthly meet-
ings with community partners. A designated community health program
manager creates linkages between the cancer center and community groups.
The center has integrated, on-site relationships with The Wellness Commu-
nity, the American Cancer Society (ACS), San Diego Hospice, and ACS's
Cancer Navigator Program, among others. Patients and families receive
help in illness self-management through an individualized orientation pro-
gram designed to empower, inform, and guide them through treatment. A
centrally located Patient and Family Education Center staffed by trained
volunteers (most of whom are cancer survivors) offers computers with
guided navigation to sources of information and services; information in
print and video form; and donated items such as blankets, pillows, hats,
and wigs. A Patient Advisory Council chaired by a family caregiver also
meets monthly and makes specific recommendations to center leadership.
For example, the council reviewed the center's physical plant before the
center opened, and reviews all marketing materials, website designs, and
patient education materials.
Follow-up on the receipt of needed services, their effectiveness, and the
need for any changes occurs in multiple ways. Rescreening of each patient
takes place whenever there is a change in treatment (unless the person was
screened within the past 30 days) or every 2 months, whichever comes first.
Program evaluation also takes place on a quarterly basis when a random
chart audit is performed.
The program staff includes eight social workers, one psychologist, one
psychology fellow, a part-time psychiatrist, one community outreach man-
ager, and many students. Social workers are funded with "hard money" as
part of the center's ongoing personnel budget. Although the psychologist
bills for services provided, complete reimbursement often does not occur
because of low payment rates and failure to receive any reimbursement
when the provider is outside the network of some third-party insurers (see
Chapter 6 for a discussion of this issue). Funding for the psychosocial pro-
gram comes from philanthropy, the cancer center itself, clinical fees, shared
programs with community groups, and grants. The director of the program
spends substantial time fundraising for an endowed foundation to cover the
costs of nonreimbursed services.
As a result of this year-and-a-half-old program, the center's scores on its
annual Press-Ganey Oncology Outpatient patient satisfaction survey have
tripled. The director identifies two characteristics of the program as key to
its success: (1) the collocation and integration of its services with biomedi-
cal cancer care; and (2) its active alliances with community organizations
(e.g., the center implements programs for The Wellness Community at the
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center and in the community, and The Wellness Community in turn pays
in part for the services of a psychologist).4
The West Clinic, Memphis, Tennessee The West Clinic consists of three
free-standing ambulatory oncology practices in metropolitan Memphis plus
three satellite offices 60–90 minutes away from the main offices. Screening
of patients for psychosocial health problems and quality-of-life assessment
take place at every visit by means of the computer-based Patient Care Moni-
tor (PCM) screening instrument (described in Chapter 4), which quickly
collects information from individuals about their cancer-related symptoms
while they are in the waiting room before meeting with the clinician.
Validated instruments gauge pain levels, fatigue, and mental health status.
Results are scored and attached to the patient's chart. More in-depth as-
sessment of individuals experiencing significant distress is provided by
psychologists located at the largest site (but able to travel to other sites as
For some psychosocial health problems, patients receive the needed
services directly on site; for others, they are referred to resources in the
community by clinic nurses and social workers on an ad hoc basis. Some
psychosocial services are offered at the three main ambulatory oncology
clinics through on-site psychologists, social workers, nurses, palliative care
specialists, other professional psychosocial staff, and volunteers, with dedi-
cated space provided for nonclinical activities. A quality-of-life interview
and information session with a psychologist are offered to every patient and
family prior to the start of treatment. Many psychosocial services are also
provided by West Clinic's approximately 200 trained6 volunteers through a
practice-based 501c3 foundation created by the clinic (Wings Cancer Foun-
dation). Coordination of psychosocial and biomedical care is accomplished
through collocated psychosocial and medical personnel.
The Wings Cancer Foundation offers support to patients and families
in illness self-management through support groups, a lending library, nu-
tritional counseling, exercise and strength building, yoga and relaxation
classes, and crisis intervention. In addition, a separate patient education
system provides wireless, notebook-sized computers (e-tablets) that pa-
tients use while waiting for their appointments or receiving treatment. The
e-tablets deploy a proprietary intranet or Internet-based system called the
Cancer Support Network, which provides patients with targeted educational
4 Personal communication, Matthew J. Loscalzo, MSW, Director of Patient and Family Sup-
port Program, Rebecca and John Moores UCSD Cancer Center, March 12, 2007.
5 Personal communication, Lee Schwartzberg, MD, Medical Director, April 13, 2007.
6 Volunteers undergo formal training on such issues as patient safety, communication, and
the Health Insurance Portability and Accountability Act.
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information in text, graphic, video, and audio formats on a wide range of
topics such as pain management, symptoms and treatment of psychological
distress, and other matters relevant to cancer care.
The West Clinic credits the commitment of its leadership for its success
in building the infrastructure and resources needed to deliver integrated
psychosocial and biomedical health services in the context of a community-
based practice.
As discussed in Chapter 4, the benefits of collocated, integrated psycho-
social and biomedical health care services include better access to needed
services for patients and greater ease of communication and coordination
between collocated providers. Moreover, some comprehensive programs,
such as that of the Moore Center, offer their services to the community at
large. The difficulties of this approach are that it requires a physical plant
large enough to accommodate diverse personnel and a sufficiently large
and varied labor pool in the community to staff interdisciplinary teams.
Moreover, some experts in pediatric cancer care report that some cancer
survivors do not want to receive services from the center in which they re-
ceived their cancer care when it is no longer necessary because of negative
emotions associated with the facility, a desire to "get on with their life,"
or the geographic inaccessibility of the facility (Friedman et al., 2006).
When collocation of services is either infeasible or undesirable, psychoso-
cial health services can be obtained through other community providers
(Approach 2) or potentially through providers located remotely from the
patient using telephone or Internet access (Approach 3).
Approach 2: Provision of Psychosocial Health
Services Using Local Resources
Kansas City Cancer Center7 (KCCC) is a full-service medical and radiation
oncology practice that includes 29 medical oncologists, 8 radiation on-
cologists, and 11 oncology nurse practitioners (NPs) and oncology certified
nurses. The center addresses patients' psychosocial health problems not by
providing the needed services on site to the approximately 200–300 patients
seen each day at its 11 urban/suburban locations, but by linking patients
with community providers.
7 Personalcommunication, John E. Hennessy, Nancy J. Washburn, and Barbara W. Adkins,
Kansas City Cancer Center, March 13, 2007.
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KCCC NPs screen patients at their initial and subsequent visits using a
one-page screening tool to detect depression, pain, fatigue, and other prob-
lems. If the patient answers yes to either of the first two questions (a two-
question depression screening tool), the Patient Health Questionnaire-9
(PHQ-9) screening tool for depression is administered to help determine
whether the patient is in fact experiencing depression. Positive findings are
addressed using a treatment algorithm standardized across clinical sites
(Adkins et al., 2005).8 If an intervention is established, the NP documents
it in a note that the physician reviews so as to be able to follow up on the
symptoms. The patient may also have a follow-up visit with the NP. NPs
and physicians often alternate seeing patients in order to assess the physical,
psychosocial, and spiritual needs of patients.
Based on the results of the screen and periodic psychosocial assessments,
KCCC nurses link patients with multiple psychosocial services available in
the Kansas City area. Cancer Action, for example, is a community-based
nonprofit agency in Kansas City offering an array of programs and services
that address the physical, social, emotional, financial, and spiritual needs of
people with cancer and their families and friends. All Cancer Action pro-
grams and services are free of charge (see http://www.canceractionkc.org).
For patients who are uninsured or underinsured, Swope Parkway Health
Center, Catholic Charities, the Alliance for the Mentally Ill of Greater Kan-
sas City, Samuel Rodgers Health Center, and Kansas City Free Health Clinic
offer mental health counseling either free of charge or on a sliding scale.
KCCC also has partnered with Metro CARE, WyJoCARE, and Northland
CARE, organizations of specialists that have agreed to take a limited num-
ber of uninsured patients. For patients who are working, many employers
have employee assistance programs that offer counseling free of charge. If
the employees need further counseling, KCCC refers them to a counselor
for continuation of care. If there is no employee assistance program where
patients work, they are referred based on their insurance.
KCCC also partners with Turning Point: The Center for Hope and
Healing, a 5-year-old 501c3 organization whose mission is to strengthen
resilience in individuals living with cancer or other serious or chronic ill-
nesses by providing education and other tools to help them manage their
illness and live life to its fullest. Turning Point served approximately 3,400
people in the Kansas City area in 2006; approximately 85 percent of
these were cancer patients, 55 percent of whom were referred by KCCC.
The more than 50 different education and support programs provided by
Turning Point to adults, children, families, and friends include counseling;
exercise classes; nutrition classes; and specialized classes such as Surviving
8 KCCC partnered with the Mid America Coalition for Health Care to create the treatment
algorithm. The coalition also recommended the use of the PHQ-9 tool.
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and Thriving, a comprehensive program for those having completed cancer
treatment and having no signs of disease, as well as a program for people
being treated for stage 3 or 4 cancer. Group programs are provided free
of charge to participants as a result of extensive partnerships with area
health care providers, employers, and others whose contributions pay for
the services. Although individual counseling generally requires payment
of a fee, Kansas City Turning Point provides up to five counseling visits
free of charge to KCCC patients or family members if the patient has ad-
vanced disease. Turning Point is unique in that its services are not just for
individuals dealing with cancer, an approach that may be more feasible in
less densely populated areas that may have fewer patients with cancer and
fewer community organizations dedicated to cancer care. The number of
individuals being served by Turning Point is growing at an average rate of
64 percent annually.9
KCCC NPs also help patients manage their illness by providing them
detailed, one-on-one education on treatment and management of the side
effects of chemotherapy. Psychosocial health issues are addressed not only
during but also after treatment. KCCC has a survivorship program that
provides education about the adjustments required after treatment. Pa-
tients are given the LieStrong® Survivorship Notebook, which contains
information on the emotional effects of cancer. In addition, NPs meet with
patients approximately 2 months after completion of treatment to address
survivorship issues.
Care coordination and follow-up are provided by the NPs, who per-
form these activities as part of their regular patient care. KCCC bills and
receives reimbursement for NP assessment, linkage, coordination, and fol-
low-up activities from both government and nongovernment payors (this
reimbursement approach is discussed in Chapter 6). No other foundation
or special funding subsidizes these activities. KCCC does have a fund set
up with the greater Kansas City Community Foundation, but is restricted
from using these funds to subsidize the costs of operations; rather, this
money is used to fund communitywide cancer education, awareness, and
prevention activities. Another fund, created by one patient's family, pro-
vides oral chemotherapy drugs to patients who cannot afford them; this
fund is administered by Cancer Action, which processes applications and
determines eligibility.
Tahoe Forest Cancer Center (TFCC), located in Truckee, California (in the
Lake Tahoe community), is another example of using community resources
to deliver psychosocial health services to patients with cancer. In this case,
9 Personal communication, Moira A. Mulhern, PhD, CEO of Turning Point, March 15,
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a major source of resources is the community's 30-bed hospital, Tahoe
Forest Hospital. A relocated oncologist and Tahoe Forest Hospital created
a solo physician ambulatory oncology practice that routinely incorporates
attention to psychosocial health needs as part of oncology care. The solo
oncologist uses hospital personnel to help address psychosocial needs of
TFCC's multidisciplinary staff of oncology nurses, social workers,
physical therapists, and others are employees of the hospital (which also
owns the free-standing ambulatory oncology office). Through these staff
(who also work at the hospital), TFCC offers psychological services; social
services; nutritional counseling; rehabilitation therapy; and support group
meetings for cancer patients, family, and friends at the hospital's local Cen-
ter for Health and Sports Performance. TFCC also offers the Look Good
. . . Feel Better Program® and provides or links to a variety of other pa-
tient supports and resources on its website (http://www.tahoecancercenter.
Patients with psychosocial needs are identified during office visits or
weekly meetings of the entire team. (The center does not yet use a standard
screening tool.) Physicians link patients to psychosocial services by checking
off "psychosocial evaluation" on a disposition sheet after patient visits. The
staff schedules an appointment with the social worker, who then provides
the necessary linkages to the psychosocial team. Coordination of biomedi-
cal and psychosocial care takes place at weekly team meetings. Follow-up
is performed at these meetings and in the interim by TFCC nurses. Patients
are supported in managing their cancer and its treatment in several ways.
Each patient receiving chemotherapy spends 1 hour with a TFCC nurse
for education about chemotherapy. In addition, patients receive custom-
ized printouts from the American Society of Clinical Oncology's (ASCO's)
People Living with Cancer that provide specific details regarding their
disease and planned treatments. TFCC also solicits volunteers from the
community to provide assistance and companionship to patients receiving
chemotherapy and help with other patient needs. TFCC's 250 patients are
covered by a variety of insurers, including Medicare (18 percent), commer-
cial insurance (61 percent), and Medicaid (19 percent); 2 percent pay out
of pocket or are uninsured.10
This approach is feasible for many oncology providers because of sub-
stantial growth in the number of providers of psychosocial health services
10 Personalcommunication. Laurence J. Heifetz, MD, Medical Director, Tahoe Forest Cancer
Center, August 10, 13, and 28, 2007.
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in many communities. According to the report, From Cancer Patient to
Cancer Surior: Lost in Transition, "There is a wealth of cancer-related
community support services available through voluntary organizations,
many of them at no cost" (IOM and NRC, 2006:229). These services
include, for example, nationwide programs of ACS, The Wellness Com-
munity, Gilda's Clubs, and other organizations that offer community-based
services at many sites nationwide (some of these are summarized in Ta-
bles 3-2 and 3-3 in Chapter 3). These services also include regional, state,
and local programs, such as Cancer Action in Kansas City and Sunstone
Cancer Support Centers in southern Arizona (see http://www.sunstone
healing.org/index.htm). This approach does not require physical space or a
large staff. It does, however, require that organizations making referrals to
other providers do so effectively, and that the referring organization have
strong follow-up procedures in place.
Approach 3: Use of Remote Providers of Psychosocial Health Services
When a clinical practice has few staff and limited resources and/or
is located where there are few or no psychosocial health care resources,
such as in rural or remote areas, the only way to provide psychosocial
health services on a frequent and timely basis may be to link patients with
remote providers through telephone or Internet access. The NCI report
Patient Centered Communication in Cancer Care, for example, notes that
"telephone help lines can be a useful source of information and emotional
support for patients with cancer" (Epstein and Street, 2007:138), and indi-
viduals with a recent cancer diagnosis, for example, often use NCI's Can-
cer Information Service to obtain information about cancer treatments in
preparation for meeting with their clinician (Epstein and Street, 2007). Even
practices that elect to deliver a wide variety of psychosocial health services
directly may not by themselves be able to provide all of the services needed
by every patient, and may still need to provide links to remote services.
For example, despite the well-developed nature and breadth of services it
provides, Moores Cancer Center refers many of its patients to CancerCare
each month for educational programs and financial assistance.
This alternative may also be preferred by some individuals, even when
psychosocial health services are available in their communities. Those with
rare cancers may wish to connect with others who have their type of cancer,
but find that the rarity of their condition means that this is impossible within
their community. Others may simply desire the convenience or anonymity
of receiving psychosocial services via the telephone or the Internet in their
own homes. Adolescents and young adults who use the Internet routinely
for multiple purposes also may prefer this mode of communicating.
Using remote resources to provide psychosocial health services to
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patients requires only that oncology providers have a mechanism for iden-
tifying patients with psychosocial needs; knowledge of a few key organiza-
tions providing a wide array of psychosocial health services to individuals
with many different types of cancer (e.g., NCI's Cancer Information Service,
ACS, CancerCare, the Lance Armstrong Foundation, and The Wellness
Community); a way to support patients in accessing these resources by
telephone or Internet; and a process for follow-up to ensure that patients
accessed the services and that the services met their psychosocial health
needs. Following is a discussion of how an organization with limited in-
ternal and local resources could address psychosocial needs following the
model put forth in Chapter 4. This approach may not always be able to
meet all psychosocial health needs; for example, some of the needed ser-
vices, such as assistance with activities of daily living and chores, may not
be available remotely. Nonetheless, this should not prevent providers from
directing patients to remote resources that can meet as many of their needs
as possible.
Implementation of the Use of Remote Resources
Clinical practices with limited resources can set the stage for effective
patient–provider communication and delivery of psychosocial health ser-
vices by communicating with patients about psychosocial health services
at the outset of care. This could be accomplished, for example, through a
short "Letter to My Patients" given to all patients at their first visit.11 This
letter could inform patients about the importance of communicating ef-
fectively and the relevance of psychological and social issues to their health
and health care. Box 5-1 contains a sample letter that oncology practices
could adapt to their own characteristics—for example, the extent to which
a practice uses a team approach to care.
Practices could then use one of the low-tech approaches discussed in
Chapter 4 that require few personnel and other resources to help identify
patients with psychosocial health needs. The National Comprehensive Can-
cer Network's (NCCN's) Distress Thermometer, for example is a one-page
screening tool, publicly available at no cost, that can be self-administered
in less than a minute. This tool could be duplicated using an office copy
machine and presented by clinical or administrative staff to all patients each
time they come in for a visit along with other routine paperwork, such as
insurance forms. When completed, the screening tool could be attached to
the patient's chart and reviewed by the clinician together with the patient
during the visit. To the extent that a clinician's evaluation of psychological
11 Thisletter could also be used by clinical practices with greater internal and community
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A Letter to My Patients
Dear Partner in Care,
As we work together to treat your cancer, I will work very hard to give you the
best health care for your cancer. As I do this, I will need your help in two impor-
tant ways.
First, you and I will need to talk with each other as clearly as we can. Medical
words can be hard to understand, and this office can be very busy, but you and
the people important to you need to understand your illness, its treatment, and all
their effects. If I or my staff don't explain things well enough or listen well enough,
please tell us.
We also need you to tell us what is on your mind. For example, what questions
do you have? How much information do you want to know? What is important to
you as you decide about different treatments for your cancer?
Second, emotional worries and problems that might not seem related to your
health care actually are. Having worries, fears, or other emotional problems can
make you feel more tired, have more pain, sleep more poorly, and get in the way
of good health care—all of which affect your heath. Your health is also affected
by problems such as not being able to pay for medications; not having a phone,
transportation, or health insurance; or not being able to work.
At every visit, we will ask you to check off a list of any emotional or other problems
you may be having. Although we may not be able to solve all of these problems
ourselves, we know organizations that can help with many of them—and these
are often just a toll-free phone call away.
Please let me or other members of our health care team know if you have any
questions. We want to give you the best health care possible!
and social problems added substantial time to the visit, the clinician could
bill at a higher rate if reimbursed on a fee-for-service basis (see Chapter 6),
although there is some evidence that use of a screening tool could reduce
visit length (Pruyn et al., 2004).
All practices should be able to provide at least some of the psychosocial
health services needed by patients—for example, information about the
patient's diagnosis and treatment options, emotional support, and help in
managing some of the symptoms of the illness and side effects of treatment.
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For those psychosocial health service needs that exceed the practice's capa-
bilities (e.g., material or logistical resources or peer support), the practice
could have available a one-page handout listing organizations that can
provide key psychosocial health services and can be accessed using a toll-
free phone number. An example of such a patient handout is provided in
Box 5-2. This handout could be adapted to include other resources, espe-
cially those locally available. The reverse side could include a broader list
of resources for those who are comfortable with and have easy access to
the Internet.
Follow-up with patients to check on their receipt of psychosocial health
services and the effectiveness of the services could be accomplished either
by checking with the patient at the next visit through the repeated use of
the original screening tool, by monitoring between visits through telephone
calls by office staff, or by asking patients or their caregivers to inform the
practice if their psychosocial health care needs are not being met.
Remote Resources
As shown in Tables 3-2 and 3-3 in Chapter 3, a substantial number of
nonprofit organizations provide psychosocial health services at no cost to
patients via toll free phone lines, interactive Internet sites, or e-mail inquiry
and response services. Virtual communities providing emotional support,
information, and sometimes other psychosocial health services also are
now commonplace. Their services are available to many cancer patients as
a result of such Internet-based initiatives as those of PlanetCancer (http://
www.planetcancer.org/html/index.php), which serves young adults, and
The Wellness Community (http://www.thewellnesscommunity.org), which
offers professionally led Internet support groups and educational programs
to adults with all types of cancers via the Internet, in addition to its 21
Wellness Communities and 28 satellite centers at physical locations across
the United States. As of June 30, 2006, 1,103 people were participating in
the Wellness Community's 11 online support groups, 7 tumor-specific and
mixed-diagnosis groups, 3 caregiver groups, 1 bereavement group, 1 teen
group, and 1 Spanish-language group.
Another remote resource is the telephone education workshops pro-
vided by CancerCare for cancer patients, caregivers, and other interested
persons. Approximately 2,000 people from the United States and countries
such as Australia, Canada, China, Spain, and the United Kingdom attended
each of three such workshops held in the first half of 2007. The utility of
the workshops is indicated by the comments of those in attendance (see
Box 5-3).
CHESS (Comprehensive Health Enhancement Support System) is
another Internet-based resource that can provide remote information,
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Example of Patient Handout on Sources of Help
in Managing Cancer and Its Treatment
If you need more information about your cancer and its treatment, you can
The National Cancer Institute. Information specialists can answer many questions
about cancer, including most recent treatment advances.
By telephone Monday through Friday, 9:00 AM to 4:30 PM within all time zones
across the United States: 1-800-4-CANCER (1-800-422-6237) and 1-800-332-
8615 (TTY for the hearing impaired) (both toll free)
Service in English and Spanish
Questions can also be sent via e-mail to: firstname.lastname@example.com
A "live" help service is available to answer general questions about cancer
and provide help in navigating the NCI website at https://email@example.com.
The American Cancer Society
By telephone 24 hours a day, every day: 1-800-ACS-2345 and 1-866-228-
4327 (TTY for the hearing impaired) (both toll free)
By the Internet at: http://www.cancer.org/asp/contactUs/cus_global.asp
If you need practical help, such as finding wigs or transportation or assis-
tance with financial problems, you can call:
The American Cancer Society (same as above)
By telephone Monday through Thursday, 9:00 AM to 7:00 PM Eastern Stan-
dard Time, and Friday, 9:00 AM to 5:00 PM Eastern Standard Time (no week-
end phone service): 1-800-813-HOPE (1-800-813-4673) (toll free)
By the Internet at: http://www.cancercare.org
If you would like to talk to someone about your concerns about having
cancer or other concerns or talk with others who are living with cancer,
you can call:
The American Cancer Society (same as above)
CancerCare (same as above)
emotional support, and decision-making and problem-solving assistance to
people with cancer and other chronic illnesses (e.g., asthma, HIV, heart dis-
ease) and caregivers of persons with memory disorders and dementia. The
design of the program is based on the results of literature reviews, needs as-
sessment surveys typically involving several hundred patients and families,
OCR for page 219
Patient Comments on the Usefulness of
CancerCare's Telephone Education Workshops
My husband and I got a lot of good information from this workshop—very good
advice at a difficult time for us. These programs are so helpful. Living in a rural
area we don't always have the resources nearby.
Thank you for helping me to understand the aftermath of my treatment, what to
look forward to and how to manage it.
What a fabulous way to reach people who, like me, are in remote areas and have
limited access to support. This forum provides a much-needed service.
Thank you for your teleconferences. It keeps us in rural areas up on the latest.
I can't thank you enough for making these available via telephone for those of us
in treatment or unable to travel.
Of course my own oncologist can't spend an hour talking with me. I feel so blessed
that [these calls] provide me with top experts and up-to-the-minute information.
The topic was one I haven't seen presented anywhere else. It was very easy to
call in and take part in the conference. I'm glad I did and I'm looking forward to
the next one.
Thank you!!! When my aunt suffered breast cancer 20 years ago, she had to go it
alone because she was too sick to get to support groups. I not only have email, but
your teleconferences and the ability to refer to the podcast again to review points I
may have missed. Thank you for taking advantage of technology for my benefit.
I actually listened via cell phone, while on vacation, sitting on the veranda of a
grand old lodge, on one of Georgia's beautiful barrier islands, overlooking a won-
derful marshy waterway that leads to the Atlantic. It was the best way I've ever
found to deal with cancer issues!
The call-in portion was also very instructive given the fact that my wife and I
have many of the same questions. After the discussion on "rocker" sole shoes,
we found a location last Saturday and purchased a pair that is already giving me
some needed comfort.
I can even participate in a conference during lunch or when I'm traveling. It's in-
credibly versatile and educational, useful and extremely helpful.
Keep these workshops coming. The more we know, the more able we are to judge
if we are getting good and up-to-date care out here in rural areas.
I love these programs. They keep me up-to-date and I can go back to my doctor
and we talk about all I have learned and I feel very in the know.
Thank you for offering these sessions and for offering them free of charge. They
really do help survivors and offer a huge community service. Thank you for also
offering the listening session after the workshop so those that miss the session
can still hear the information.
SOURCE: CancerCare, 2007.
OCR for page 219
focus groups and interviews, and an ongoing demonstration. Because it ad-
dresses multiple conditions, the program can serve as a "one stop" resource
for individuals who have other illnesses in addition to cancer.
CHESS services are accessed through home-based computers (organiza-
tions using the program often lend computers to patients who do not have
them). As an example, information services for prostate cancer include
brief answers to 400 frequently asked questions, links to more than 200
articles from the scientific and popular press, and WebLinks to connect
users to other high-quality websites specific to the illness. A resource di-
rector also identifies local and national services and ways to connect with
them. For emotional support, CHESS offers patients and families bulletin
board–style discussion groups, each of which is limited to 50 participants
and is professionally facilitated. Ask an Expert provides confidential re-
sponses to questions via NCI's cancer information service. Personal stories
written by professional writers who interview people with cancer, as well
as videos, show how individuals have managed problems frequently identi-
fied through needs assessments. Analysis, assessment, and decision-support
services help patients think through issues important to them and make be-
havior changes. A health-tracking program collects data on an individual's
health status every 2 weeks and charts change over time. The design of
CHESS accommodates various coping and information-seeking styles by
tailoring information and support to users' interests.
A team of decision, medical, information, and communication experts
designs the decision-making and health-tracking tools. All CHESS modules
are pilot-tested, then further refined on the basis of patient and clinician
feedback before being released for dissemination. Modules are updated
regularly to ensure that their content is accurate, relevant, and current and
to improve their ease of use. All information is reviewed and updated (if
needed) annually by advisory panels that include a range of professionals
and patients. Intra-CHESS links and links to external websites also are
checked biweekly. Patient feedback is actively solicited to identify voids in
information and guide the development of system enhancements. Clinicians
at participating research sites are encouraged to provide ideas for how
CHESS can be adapted to better meet their needs. In addition, health care
organizations are urged to review the content of modules before using them
with their patients. Suggestions, questions, or feedback on the program
content can be e-mailed to CHESS.
CHESS has been studied extensively across multiple illnesses, including
cancer, and in a number of different ways, ranging from randomized trials
and field tests designed to assess its impact on quality of life (Pingree et al.,
1996; Gustafson et al., 1999; Shaw et al., 2006) to evaluation of the cost
and effectiveness of different methods for disseminating the CHESS systems
(Gustafson et al., 2005a,b). Results of these studies show positive effects on
OCR for page 219
multiple dimensions, including emotional well-being, functional well-being,
competence in dealing with health information, participation in health care,
and quality of life. Other important findings are that underserved popula-
tions used CHESS more than socially advantaged populations and that they
used it for different purposes. The former used the program more often to
locate and analyze information and the latter more to participate in discus-
sion groups (Gustafson et al., 2001, 2002).
Formerly a demonstration program, CHESS is now an ongoing program
with continued operation and updating provided by the University of Wis-
consin Comprehensive Cancer Center. Oncology practices and individual
patients desiring to use it can do so.12 The CHESS breast cancer program
is available on the web in English and Spanish versions. The English ver-
sion (Living with Breast Cancer) can be accessed at http://www.uwchessbc.
org. The Spanish-language site, "Conviviendo con el Cancer de Seno," is a
cultural and linguistic translation of the existing online Living with Breast
Cancer program. The translation was performed by a multinational team
from Mexico, Argentina, and Venezuela with guidance from the Dane
County Latino Health Council. Partners, including the National Latino
Cancer Research Network and the Center for Patient Partnerships, provided
additional Latina-specific content. Conviviendo con el Cancer de Seno can
be accessed at http://www.chess.wisc.edu/espanol/.13
As useful as approaches such as The Wellness Community, CHESS,
and other online and telephone services may be, there are some obstacles
to their use. First, not all consumers may have access to the technology or
the ability to use it in their homes, even if it is provided to them. Patients
using entry-level computers with slow modems can be "timed out" by their
Internet provider during a support session, causing an interruption in their
participation. Second, it may not be possible to deliver all needed psycho-
social health services on line. Delivery of mental health services over the
Internet is still an evolving technology, and other services, such as cognitive
testing, educational support, and support in performing activities of daily
living, must still be provided directly. Nevertheless, telephone and Internet
support can be used to provide some psychosocial health services, and clini-
cians should not let an inability to ensure the provision of all such services
prevent their taking action to ensure the provision of as many as possible.
12 By contacting 1-800-361-5481.
13 Personal communication, David Gustafson, University of Wisconsin-Madison, July 10,
2007, and Fiona McTavish, Deputy Director of CHESS, July 16, 2007.
OCR for page 219
Based on the evidence presented in Chapters 3 and 4 and the additional
evidence presented in this chapter on the feasibility of providing psycho-
social health services in accordance with the standard recommended in
Chapter 4, the committee makes the following recommendations.
Recommendation: Health care providers. All cancer care providers
should ensure that every cancer patient within their practice receives
care that meets the standard for psychosocial health care. The National
Cancer Institute should help cancer care providers implement the stan-
dard of care by maintaining an up-to-date directory of psychosocial
services available at no cost to individuals/families with cancer.
In making this recommendation, the committee appreciates that patients
diagnosed with cancer are treated for their illness by many different types
of providers—some specializing in oncology and others, such as primary
care physicians and general surgeons, who have a patient population that
is more heterogeneous with respect to diagnosis. Patients with cancer may
make up a minority of patients seen by the latter clinicians. The committee
believes that all providers should implement the above recommendation,
but appreciates that those whose practices are not devoted to oncology
may have other strategies, standards, and expectations placed on them by
experts in the care of patients with other diseases. While the committee
believes that the standard of psychosocial health care has applicability to
all chronic diseases (as illustrated by the breadth of clinical conditions ad-
dressed by the models of care reviewed in Table 4-1 in Chapter 4), it calls
upon oncology practices to lead the way in implementing this standard of
care and providing cancer care "for the whole patient."
In making this recommendation, the committee also appreciates that
there is not currently as ample a supply of psychosocial services as is nec-
essary to meet all the needs of all patients, and some problems (such as a
lack of health insurance and poverty) can be addressed only in a small way.
Nevertheless, the committee urges all involved in the delivery of cancer care
not to allow the perfect to be the enemy of the good. The inability to solve
all psychosocial problems permanently should not preclude attempts to
remedy as many as possible—a stance akin to treating cancer even when a
successful outcome is not assured. Patient education and advocacy organi-
zations can play a key role in bringing this about.
Recommendation: Patient and family education. Patient education
and advocacy organizations should educate patients with cancer and
their family caregivers to expect, and request when necessary, cancer
OCR for page 219
care that meets the standard for psychosocial care. These organizations
should also continue their work on strengthening the patient side of the
patient–provider partnership. The goals should be to enable patients
to participate actively in their care by providing tools and training in
how to obtain information, make decisions, solve problems, and com-
municate more effectively with their health care providers.
Finally, the organizational, financial, and size differences among cancer
care practices may influence the strategies providers use to implement the
standard of care. For example, the economics of collocation and care coor-
dination is affected by the volume of cases. Local resources also influence
the way in which care is organized.
The committee concluded that evidence is sufficient to establish a stan-
dard for the delivery of psychosocial health care to patients with cancer.
At the same time, as discussed in Chapter 4, much of the research under-
pinning this recommendation comes from populations with diseases other
than cancer, and evidence in support of the individual components of the
model is of variable strength. Thus a large-scale, systematic program dem-
onstrating and evaluating the effects of the implementation of the standard
of psychosocial health care at various oncology sites (e.g., comprehensive
cancer centers attached to medical centers, freestanding oncology practices,
and smaller oncology practices located outside of urban areas) would pro-
vide useful information about different ways to implement the standard
as a whole and its individual components more efficiently in oncology
practices and the impact of doing so. Demonstrating the model of care in
general medical practices would provide additional valuable information.
Patients with cancer may not constitute the majority of the patients of such
practices, and a demonstration could address how these practices could
implement the standard of psychosocial care. For example, would such a
practice adopt the standard only for patients with cancer, for patients with
other complex conditions as well, or for all patients? Such a demonstration
program would allow the model to be honed over time and generate ad-
ditional examples of how it can be implemented efficiently and effectively.
Moreover, measuring such outcomes as reductions in unmet needs and
levels of distress, adherence to treatments, and cost-effectiveness would
make it possible to compare different approaches to implementing the
standard. A demonstration also could document effects of and approaches
for successful implementation of the standard among vulnerable groups,
such as those with low socioeconomic status, ethnic minorities, those with
low health literacy, older adults, and the socially isolated. In addition, such
a demonstration could examine different models of reimbursement, reveal
additional ways of implementing the standard in resource-rich and non-
resource-rich environments, and test the feasibility and soundness of perfor-
OCR for page 219
mance measures for psychosocial health care. The demonstration could also
examine how various types of personnel can be used to perform specific
types of interventions and how those personnel can best be trained.
Recommendation: Support for dissemination and uptake. The Na-
tional Cancer Institute, the Centers for Medicare & Medicaid Services
(CMS), and the Agency for Healthcare Research and Quality (AHRQ)
should, individually or collectively, conduct a large-scale demonstra-
tion and evaluation of various approaches to the efficient provision of
psychosocial health care in accordance with the standard of care. This
program should demonstrate how the standard can be implemented in
different settings, with different populations, and with varying person-
nel and organizational arrangements.
AAMC Center for Workforce Studies. 2007. Forecasting the supply of and demand for
oncologists: A report to the American Society of Clinical Oncology (ASCO) from
the AAMC Center for Workforce Studies. http://www.asco.org/ASCO/Downloads/
Cancer%20Research/Oncology%20Workforce%20Report%20FINAL.pdf (accessed
August 15, 2007).
Adkins, B., T. Titus-Howard, V. Massey, N. Washburn, J. Molinaro, B. Lange, W. L. Bruning,
S. Simmons, P. Gerken, V. Sommer, K. LaNoue, B. Rogers, and B. Wilson. 2005. Recog-
nizing depression in cancer outpatients. Community Oncology 2(6):528–533.
CancerCare. 2007. CancerCare Connect™ telephone education workshop: Report to the
National Cancer Institute and Lance Armstrong Foundation unpublished data. New
York: CancerCare.
Epstein, R. M., and R. L. Street. 2007. Patient-centered communication in cancer care: Pro-
moting healing and reducing suffering. Bethesda, MD: National Cancer Institute.
Friedman, D. L., D. R. Freyer, and G. A. Levitt. 2006. Models of care for survivors of child-
hood cancer. Pediatric Blood & Cancer 46(2):159–168.
Friedmann, P., T. D'Aunno, L. Jin, and J. Alexander. 2000. Medical and psychosocial services
in drug abuse treatment: Do stronger linkages promote client utilization? HSR: Health
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1999. Impact of a patient-centered, computer-based health information/support system.
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Gustafson, D. H., R. Hawkins, S. Pingree, F. McTavish, N. K. Arora, J. Mendenhall,
D. F. Cella, R. C. Serlin, F. M. Apantaku, J. Stewart, and A. Sainer. 2001. Effect of
computer support on younger women with breast cancer. Journal of General Internal
Medicine 16(7):435–445.
Gustafson, D. H., R. P. Hawkins, E. W. Boberg, F. McTavish, B. Owens, M. Wise, H. Berhe,
and S. Pingree. 2002. CHESS: 10 years of research and development in consumer health
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OCR for page 219
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10(Supplement 1):157–172.
Gustafson, D. H., F. M. McTavish, W. Stengle, D. Ballard, E. Jones, K. Julèsberg, H. McDowell,
G. Landucci, and R. Hawkins. 2005b. Reducing the digital divide for low-income women
with breast cancer: A feasibility study of a population based intervention. Journal of
Health Communication 10(Supplement 1):173–193.
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grams: Implications for closing the digital divide. American Behaioral Scientist 49(6):


text:
Hi: 9° Lo:2°
INDEPENDENT candidate Bill Longmore has swept to victory after being elected as West Mercia's first ever Police and Crime Commissioner.
The former police officer beat rivals with 71,955 votes after two rounds of counting, having failed to pick up 50 per cent of the vote first time round.
During the campaign Mr Longmore, who spent 30 years with Staffordshire Police, promised to ensure local policing teams were properly resourced, tackle anti-social behaviour and improve the relationship between the police and partner organisations such as the council, community and voluntary sector.
He also pledged to monitor police numbers and challenge the Government on cuts which compromise the effective delivery of frontline policing.
Labour candidate Dr Simon Murphy was eliminated after the first round with only 34,652 votes.
When Dr Murphy's votes were redistributed to the other two candidates based on their second preference, Mr Longmore received over 21,000 votes compared to just 5,201 for Mr Blackshaw, leaving him with a final total of 54,499 votes.
Despite the fact Dr Murphy had come first in Redditch and Worcester, he failed to win support across the rest of Worcestershire and the majority of West Mercia.
In the borough, Dr Murphy received the most votes with 2,688 originally beating Mr Longmore by 150 votes. Mr Blackshaw came last with 2,242 votes.
In neighbouring Warwickshire independent candidate Ron Ball was also celebrating after being elected as Police and Crime Commissioner for the county.
It has been hailed the worst turnout in the UK's history, something which was echoed in Redditch where only 7,824 people turned out.
In the Bromsgrove section of the vote, Conservative Adrian Blackshaw won by just five votes.
He notched up 3,631, with independent Bill Longmore finishing second with 3,626. Labour's Simon Murphy finished third wth 2,244.
It was a disappointing turnout, with just 13.3 per cent of those eligible across the district using their right to choose.
In total 9,777 voted, but there were 276 rejected ballot papers.
The new commissioner will be responsible for setting West Mercia Police's budget, policing priorities and hiring or firing the chief constable, although the force will retain operational independence so decisions about investigations cannot be influenced by politics.
Nationally turnout is predicted as just 18.5 per cent, a record low. The Electoral Reform Society has described the election as a 'comedy of errors'.
Votes cast in Redditch were verified at the Town Hall last night before being escorted to Shrewsbury for counting as Shropshire Council is overseeing the election for the West Mercia area.
1 Murder investigation launched after double stabbing in Northfield leaves one teen dead
2 200 worth of damage caused to car in Bromsgrove
3 Second man arrested over Northfield murder
4 French windows smashed in Bromsgrove burglary
5 Princess Anne opens 25million county cancer treatment centre
A BMW 318i, burnt out in Bromsgrove in
A MAN has been charged in connection with
RESIDENTS have been urged to attend a meeting
A WOMAN is in a critical condition in
CAMPAIGNERS fighting to save services at the Alexandra Hospital have ...
STRATFORD District Council has handed over £2,215 worth of unused ...
Visit the Worcester Observer website for the latest.
OFFICERS searching for missing Pershore man Ernest Upward have discovered ...

subset: commoncrawl


text:
Ireland (IE) Mud Runs & Obstacle Races
A complete list, guide & directory to obstacle races, adventure runs, and mud runs in Ireland
Click an event name below to see course descriptions, obstalce lists, coupons, discounts, prizes, awards, parking cost, spectator fees and more about each event.
May 30, 2015 |
Monaghan Ireland King Muck 2015 |
Browse our list of previous mud runs, mud races & obstalce races for Ireland (IE)
Know of an event we're missing? Let us know and we'll get it added. It's completely free!
Don't forget, you can always use our handy Worldwide Mud Run Finder to search for an event using our interactive map!


text:
Knit your own Crest of the Wave Lace Scarf using these clearly-written instructions by knitwear designer Jackie E-S of HeartStrings FiberArts.
This lovely lace scarf is named after its main pattern stitch "Crest of the Wave", a derivative of the popular Shetland lace stitch Feather and Fan or Old Shale. The main stitch area of graceful lacy waves is surrounded by a knit-as-you-go elegant ribbed openwork border.
Allow 500 yards of lace or fingering weight yarn for 14" x 60" scarf, or desired length with yardage adjustment. 4½ stitches/inch, size US 6 / 4.0 mm needles suggested. Main photo shown in Mountain Colors Winter Lace Junior, color Chinook. Charted and written stitch instructions.
Preview sample cover page


text:
Gender differences in knowledge transfer in school mathematics
Jay, T., 2005. Gender differences in knowledge transfer in school mathematics. In: 6th British Congress of Mathematics Education, 2005-01-01, University of Warwick.
Related documents:
This repository does not currently have the full-text of this item.You may be able to access a copy if URLs are provided below.
Item Type | Conference or Workshop Items (Paper) |
Creators | Jay, T. |
Departments | Faculty of Humanities & Social Sciences > Psychology |
Refereed | No |
Status | Published |
ID Code | 9459 |
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text:
Per Vices is a startup from the latest class that's looking to disrupt how wireless communications are sent. They've built a device called Phi that can interact with any wireless or radio signal. It's a transceiver that can demodulate and process signal data up to 4 Gigahertz.
In plain English, that means one of Per Vices' devices can re-route your cell phone calls through your landline connection, if for example you have bad 3G service in your house. In theory, that means you could set up a decentralized wireless network where mobile devices and desktops are sending communications to each other instead of one where all mobile phones have to send and receive signals from carrier-operated cell phone towers. It's a critical issue the industry needs to solve as data-hogging mobile subscribers eat into the profit margins of the carriers.
Y Combinator alum Crocodoc is debuting a new technology today that aims to bring an enterprise-grade HTML5 document embedding service for Microsoft Office and PDF files to web-based products.
Crocodoc launched in 2010 to kill off Acrobat. The startup's initial Flash-based technology allowed you to upload a PDF, and receive a version of the same document in your browser, which you could then share with coworkers and annotate with notes, highlighting, text, and a pen tool, with changes that show up to other users in real-time. Last year, Crocodoc launched this technology in HTML5 for mobile embedding.
Recent Y Combinator graduate SendHub, which bills itself as SMS for organizations, is in the business of replacing the email blast with an SMS message and aims to solve a myriad of real-world consumer, business, and enterprise one-to-many communication challenges.
SendHub has just closed a $2 million seed round led by Kapor Capital, the company exclusively told VentureBeat. Howard Lindzon's Social Leverage fund, 500 Startups, Bronze Investments, Menlo Ventures, and angels including Eric Ries, Paul Buchheit, and Jawed Karim all participated in the round.
At Y Combinator's Demo Day, a short Ark pitch delivered in the midst of 64 other start-up presentations got the company commitments for $2 million in funding in a single day. And more than 250,000 people have signed up for Ark beta invites.
Less than a month after Demo Day, Ark now tells me that it has raised a $4.2 million seed round from investors including Andreessen Horowitz, Charles River Ventures, Greylock Partners, Intel Capital, SV Angel, Atlas Ventures, Crosslink Capital, Expansion Venture Capital, Felicis Ventures, Lightbank, Salesforce, Tencent, Transmedia Capital, and a bunch of individual angel investors.
The team that brought us Taskforce last year has returned with much more powerful project management software (think Basecamp killer) with deep integrations into all the tools we already use: Google Docs, Google Calendar, and Dropbox.
Eric Eldon writes more on Techcrunch in their launch:
Siasto might seem a little too familiar at first, as it uses the same concepts as you've seen in competing products like Basecamp. You create projects, you add tasks to them, you upload documents, you invite other users, and so on. What's special is the how the Y Combinator-backed company has organized the interface, and how it's busy tying in with Google.
Congrats to Eric and the InPulse team (YC W11) -- they've created something truly remarkable in the Pebble e-Paper watch.
So far, Migicovsky has raised more than $3.8 million (ed: now $4.1M), making the watch the highest-grossing project since Kickstarter was founded two years ago, a spokesman for the website said. The fundraising will go for another 31 days, and then Pebble gets to collect the money it has raised.
Kickstarter takes submissions from aspiring authors, hardware tinkerers, thespians and video-game developers with good ideas and video cameras to shoot their pitches. Some 1.75 million people have given more than $185 million to 20,000 projects on Kickstarter, a spokesman said.
Migicovsky said he's more adept at pitching to consumers than to venture capitalists.
"With VCs, they worry about models and size of market and stuff like that," he said. "With consumers, one of the things I love about the videos, we just showed how you're going to use it."
On Tuesday, Everyme launched its iPhone app for people to share with limited circles of friends, family members, and coworkers. Today, CEO Oliver Cameron says the response has been "crazy."
Specifically, he says that 24,000 people have created Everyme accounts. Because of the way Everyme is designed, that's only a small part of its social footprint. The app lets you organize anyone in your address book into circles, and they can still participate in the conversation through email or text messaging, even if they don't have an Everyme account. There are already 200,000 people in Everyme circles, which Cameron says is a measure of the app's "total audience."
It's a Platform Cloud. But Not Really
That said, if you want to set up your own servers for security reasons or additional processing power, you can do so. Firebase will still handle the data, and your servers can tap into this central repository in much the same way clients do.
The service's primary aim is to simplify application development. If you move all your code into the clients, Lee says, you can more easily scale to a large number of users. "All these cloud providers claim that if you go into the cloud, you can scale automatically, but that's only true if you wrote your code to shard across multiple servers, which is extremely difficult to do. Most people just don't do that," Lee says. "But if you don't have to do server-side at all, and you build your application to use this API, we can shard your data for you and scale your application automatically."
There's a few things that make Kaleidoscope a standout. For one, its high-quality feed of street-style images. Instead of depending on user-generated content for fashion inspiration, Kaleidoscope displays thumbnails of photographs pulled from lookbook.nu or produced on its own. Between 30 and 50 new images are posted each day. The startup is currently forming partnership with select bloggers to bring their content to Kaleidoscope's feed as well.
Kaleidoscope also brings quality curation to another key part of its service: product recommendations. The app uses ShopStyle's API to locate products that match the clothes in each photograph, and internal staff — i.e., the startup's interns — filter through the options to offer users the best fit.
We also like the app's integration with third-party networks. It's easy to share looks straight to Facebook, Twitter and Pinterest.
Meetings.io is the latest step in the evolution of videoconferencing services, a classic example of enterprise-focused social networking, which have always held much potential but also frustrations. Starting out as services only for the biggest enterprises that could afford expensive equipment and software, eventually videoconferencing offerings trickled down to Internet-based, mass-market products for anyone (business or consumer) to use with a connected PC or mobile device equipped with a microphone and camera.
But even so, they came with a catch: with Skype, GoTo Meetings and WebEx, you need to download software, and pay fees (as you do with Skype to enable more than a one-to-one conversation); with Google, you need to join its social network to use Hangouts. "But you may not want to do that for someone who may be only a short-term contact," says co-founder Arend Naylor (via a Meetings.io link).
And that's before any and all technical glitches.
These are all barriers that Meetings.io is attacking with a very simple, peer-to-peer service aimed not at early adopters and those more technically-minded, but those who need to make a group call for work and without the painful process of setting that up. The aim: "Something lightweight that works without software," says Naylor. The result: to initiate a call, a registered user simply sends out a link, or invites people to visit a meeting room.


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Wilding, M. C. and Macdonald, R. and Davies, J. E. and Fallick, A. E. (1993) Volatile characteristics of peralkaline rhyolites from Kenya: an ion microprobe, infrared spectroscopic and hydrogen isotope study. Contributions to Mineralogy and Petrology, 114 (2). pp. 264-275. ISSN 0010-7999
Full text not available from this repository.Abstract
Peralkaline rhyolites of the Greater Olkaria Volcanic Complex, Kenya Rift Valley, were derived from separated, though closely related, magma chambers. Ion microprobe analyses of glass inclusions in quartz phenocrysts show pre-eruptive water contents of up to 3.4 wt% contrasting with previous estimates that the magmas were anhydrous. The values approach predicted solubility levels corresponding to water saturation at low crustal pressures (1 kbar). The glass matrices of the rhyolites have low water contents, ranging from 0.07 to 0.46 wt%, suggesting significant degassing during, or prior to, eruption. Infrared measurements of the matrix glasses show variation in the relative proportions of the two hydrous species dissolved in the glasses. The amount of molecular water, determined semi-quantitatively, apparently increases with increased fluorine content and peralkalinity. This suggests a competition between hydroxyl groups and fluoride ions for similar sites within the melt structure. The mechanism of degassing has been investigated using hydrogen isotopes. The range of D values in most rocks can be produced by varied degrees of open-system degassing of rhyolite melt initially in equilibrium with water of a fixed, or limited, D value. There is evidence to suggest that closed-system degassing may also have been a significant component in some rhyolites. The exact mechanisms of degassing remain uncertain. Particular problems include the relative contribution of open-and closed-system degassing during eruption and the initial vapour compositions and solubility relationships.
Item Type: | Article |
Journal or Publication Title: | Contributions to Mineralogy and Petrology |
Subjects: | G Geography. Anthropology. Recreation > GE Environmental Sciences |
Departments: | Faculty of Science and Technology > Lancaster Environment Centre VC's Office |
ID Code: | 22708 |
Deposited By: | ep_ss_importer |
Deposited On: | 15 Jan 2009 09:40 |
Refereed?: | No |
Published?: | Published |
Last Modified: | 07 Jan 2015 13:42 |
Identification Number: | |
URI: | http://eprints.lancs.ac.uk/id/eprint/22708 |
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American Association of Feline Practitioners
The Kansas State University Student Chapter of the American Association of Feline Practitioners began in the fall of 1987. Objectives of the organization include enhancing the educational opportunities of veterinary students at Kansas State in the areas of feline medicine and surgery, and promoting cooperation between veterinary and cat fancy organizations.
This is a small organization here at Kansas State, which allows us the flexibility to plan activities which benefit all members, and allows us the ability to offer members hands-on opportunities to gain skills. Our membership is not limited to just those students interested in exclusive feline practice, but we have members interested in small animal practice, as well as some planning employment in mixed animal practices.
Elections are held in March, with President, Vice-President, Secretary, and Treasurer selected for the following calendar year. Dues are $10.00 and cover the fall and spring semester. Meetings are held once a month with a speaker presenting a topic of interest.
Faculty Advisor | |
Dr. Ken Harkin | firstname.lastname@example.com |
2013-2014 Student Officers | |
President | Jessica Chavera, 2015 email@example.com |
Vice-President | Brianna Hafer, 2015 firstname.lastname@example.com |
Secretary | Misty Yancey, 2015 firstname.lastname@example.com |
Treasurer | Sarah Halpern, 2016 firstname.lastname@example.com |


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Winsdown Farms McAlester, Oklahoma Contact: Winsdown Farms Phone: 918-546-2279 Click here to email this stable |
About Us |
Winsdown Farms is dedicated to the breeding and development of user friendly, sound of mind and body Saddlebred show horses that are versatile fun, boarding barn compatible and if the owner so chooses competitive at most shows in all divisions from In Hand to Hunt to Western to Pleasure Driving, to Harness, to Park and The Gaited Divisions. |
Post On Your Own Social Network! |
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Give your support and Like this Stable's Ad? Click the Like button below! And if you are logged in on FB while you view this ad, you can see other members who also like this listing!
HorseShowCentral is the place to locate shows, the best stables, stallions at stud, those who offer show services, associations, businesses, rescue, and property for sale! Not to mention articles on breeds, styles and disciplines of showing, along with HSC's stupendous Advertising!
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More Scams To Be Aware Of
Answer your phone, open your e-mails and the scams find you!
How To Spot Suspicious Emails
Here are some ways to spot a malicious email just in case your spam filter doesn't catch it.
More Ways To Protect Yourself From Fraud
Attorney General Healey's office has joined the battle to protect against fraud and will be holding informational meetings around the state all week.
How To Avoid Fraud
If you think you've found a good deal but you aren't familiar with the company, check it out online using search words like "review," "complaint," or "scam."
It's National Consumer Protection Week!
This is the beginning of National Consumers Protection Week, a national campaign to help consumers make better-informed decisions and avoid being scammed.
The Discretionary Items In Your Budget
We have been discussing saving on what we eat. Let's quickly look at a few more discretionary items in your budget.
Save On Dinner For Two
Yesterday we talked about take-out food for a family of four, but what if there's just two of you and you like to eat out several times a week?
Save On Dinner
Earlier this week we discussed saving money by eating breakfast at home and packing lunches. Now it's time to save on dinner.
Small Changes To Save More
This is America Saves Week and all week we'll be looking at small changes you can make to save big.
It's America Saves Week!
Today starts a national campaign for Americans to save more money.


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Founder of Leader In LESS Instrumentation Is Selected for Industry Leader LESS Panel at Cleveland Clinic Medical Innovation Summit
FRAMINGHAM, Mass., Jan. 29 /PRNewswire/ -- Cambridge Endo, a pioneer in the rapidly emerging LESS (also called Single Port Access Laparoscopic Surgery or SPA) market, is pleased to announce that its president and founder, Woojin Lee, was among the industry leaders selected to be on a LESS panel at the Cleveland Clinic Medical Innovation Summit. Cambridge Endo developed, manufactures and markets the innovative Autonomy(TM) Laparo-Angle(TM) articulating instruments which, it believes, is the enabling technology that will drive the rapid uptake of this major advance in laparoscopic surgery.
In traditional laparoscopic surgery, the surgeon makes three to six "keyhole" incisions in multiple sites, inserts instrumentation into each "keyhole" and performs the surgery. In LESS/SPA, only one incision is made through the umbilicus (navel). All of the instruments go through this single "keyhole." Said Lee, "LESS/SPA has been called 'scarless' surgery."
According to the Cleveland Clinic, the key criteria used in selecting LESS/SPA as one of the top 10, "game changing" innovations of 2009 were:
Inderbir S. Gill, M.D., Chairman of Urology at the Cleveland Clinic commented, "[we] performed LESS live-donor nephrectomies in nine consecutive kidney donors for kidney transplantation. All aspects of kidney harvesting were completed though the navel. Instead of a visible six-inch scar
SOURCE Cambridge Endo Copyright©2009 PR Newswire. All rights reserved |


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Money for Nothing: Comment & Share Here Politicians say the darndest things. PolitiZoid proves that truth really is stranger than fiction in the world of politics. PolitiZoid's animation is created using only the finest ingredients such as actual sound bites from your elected officials! For more information - and more videos - go to PolitiZoid.com Follow PolitiZoid on Twitter: http://twitter.com/politizoid | |


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Cinder the Cyborg "Lunar Chronicles"
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This art/photo has 2 comments. Post your own now!I like this the name is really cute. Is her waist a little skinny or is it just me(though lots of anime follow that style)?


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BB gun prompts scare at Highlands High School
Officials: Former student brings unloaded BB gun to show friend
UPDATED 6:19 PM EST Dec 06, 2012A former student prompts a scare when he brings a BB gun to Highlands High School in Natrona Heights.
The views expressed are not those of this site, this station or its affiliated companies. By posting your comments you agree to accept our terms of use.blog comments powered by Disqus


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M and I visited BalMar last night. They've only been open a couple of weeks and normally that's not a really great time to visit a new place but we were in the neighborhood and thought we'd give it a shot.
The space is really great. Lots of banquette seating, a few booths, and a nice long bar on the first floor. I noticed stairs but didn't go up and I'm not sure if it's even a public area upstairs. The whole space calls you to linger for awhile, hopefully in the company of friends.
The menu is all over the place. Chinese-style ribs, risotto, a nod to Ballard's Scandinavian history with lingonberries, lots of seafood – a bit of everything. The cocktails however, seem to be serious cocktails. I had a Capri Martini and it was a very grown-up drink! M had something with Tequila and grapefruit which was another good option.
The food however was a bit lackluster. We tried the aforementioned ribs and risotto. The ribs were covered with a beautiful sweet-sour tangy sauce – yummy! They were also accompanied by a little salad of citrus fruits and (we think) pickled rhubarb. My only complaint about this dish was that there were three ribs, which I always think is bad form for a dish meant to be shared. Please, please have an even number as most appetizers are shared by two or more people. Especially, when it's something like ribs that the odd piece can't be split. With something like Bruschetta you can cut it in half but not with a tiny rib! And if you must have an odd number make it five, it's just much more democratic that way.
The risotto was another story. It was a wild mushroom risotto but there was really no flavor. Both M and I added salt and pepper and both of us are generally no/low salt people. Even with the extra seasoning the risotto was flat. I tried adding some of the sauce from the ribs but that just ruined the sauce! :-)
One other thing that bothered us, was that at one point, the chef went out for a smoke break and took it right outside the front door. That is just bad form, I don't care how good the chef is. And it's irritating when the food is sub-par.
Having said all this, it is just their second week and I think the quality of the drinks, as well as the attention and care taken with the space itself is a very good sign. I will definitely try the place again after the first of the year. I think they have loads of potential. They just need to work out the menu. Maybe a little practice, maybe a little fine-tuning, maybe just a bit more focus but something to refine it and bring it up to par with the rest of the operation.
Too bad. I hate spending money on food I can easily prepare in my own kitchen. And I bet this place wasn\'t very cheap either.
You know it\'s in the ballpark of other places of this type. ~ B
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The exchange rate taken from Oanda.com is just for your reference
Cape Town Tours & Activities
Township Tour half day
Photo Gallery
Please Contact Us for latest rates and special deals.
Pickup info:
Guests will be collected from their place of accommodation if located in the city centre of Cape Town and within a 10 kilometre radius.
Guests staying in outlying areas will be charged an additional collection fee.


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Professional Las Vegas Dentistry Practice, Announces Teeth Whitening Raffle
The professional offices of Smiles Today Dental, which delivers a full array of professional dental services for residents and those individuals who work in the Las Vegas area as well as its neighboring communities, recently announced that it is featuring a free raffle to win $300 worth of teeth whitening services.
Las Vegas, Nevada (PRWEB) April 27, 2013
A professional dentistry practice located in Las Vegas, Smiles Today Dental recently made an announcement that it is featuring a free raffle to win $300 in teeth whitening services. This dental office offers a wide variety of general and advanced dentistry practices to its patients.
A representative of Smiles Today Dental has this to say about their recent decision to feature a raffle to anyone interested in entering it, "We relish the chance to give someone the opportunity to have whiter, brighter teeth without having to pay for them." They further explain their generosity, "Not everyone has dental insurance, and many people don´t have the kind of coverage that pays for cosmetic dentistry. We just want everyone to have the opportunity to feel like they can smile today and every day."
Anyone who is interested in entering the raffle can do so simply by visiting the website. All you need to enter is to submit your email address and click "Enter the raffle." The winner will be contacted at the close of the raffle, which has yet to be decided.
A professional Las Vegas Dentistry practice, Smiles Today Dental provides reasonably priced dental services to residents of the Las Vegas area as well as to individuals who work there. The group offers the ultimate in customer service and convenience by opening its doors seven days a week and providing free roundtrip transportation for its patients. This Las Vegas Dental practice performs an assortment of basic dental procedures including dental exams, cleanings, x-rays, braces, extractions, fillings, veneers, crowns, implants, and dentures.
Smiles Today Dental
Las Vegas Dentistry Professionals
1580 East Desert Inn Road
Las Vegas, NV 89169
For the original version on PRWeb visit: http://www.prweb.com/releases/prweb2013/4/prweb10678379.htm


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My pussy is dripping someone needs to eat me out then duck me hard
oh my gosh i loved it
from 8:29 onwards got my juices really flowing....i would have liked to have seen the kissing at the end with some tongue though!
the dark haired girl is very sexy...her body is wow....that was so hot...but those nails are got to hurt...if they are going to finger each other at least cut those nails...ouch!
I need a towel Oh my Zuzanna is so sexy hot
i love lesbian sex
Anybody is guy or lesbian , try to message me .. We are gonna have lots of fun
Yeah .. I am luving lesbians
Go girls!
Hot and sensual ...tingly feeling beggining
Hey! Two girls having a nice fun time. We know how to make each other happy !
Fuck this is amazingly hot!!!
The brunette is rlly rlly hot
so wonderful. this needs some cock though to fuck the blonde


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We have transitioned Ask Trevor into a broader, more effective resource for LGBTQ young people and their allies.
Please check out our new FAQ page here: http://TrevorSupportCenter.org
help me
I don't deserve to live. I have a blade and I am thinking of pulling with it I also have ha gun I wanna kill myself but irony won't to….
It takes a lot of courage to reach out and share how you are feeling – you should be proud of yourself. It sounds like you are in a dark place and that must be really hard.
Feeling like you don't deserve to live is very serious. Please call our 24/7 Lifeline at 866-488-7386. Please also consider reaching out and being open, about your suicidal thoughts, with someone you trust, preferably an adult such as a family member, counselor, neighbor, teacher, or anyone else you think could help.
If you're looking to talk to other young people about your feelings or others going through similar issues, you can check out TrevorSpace, our social network for LGBTQ youth and allies. It can be a great way to make friends and find support from all around the world. The address for TrevorSpace is http://www.trevorspace.org . TrevorSpace also has a discussion forum called Q&Q (Queer and Questioning) where you can post questions and discuss what you're going through with thousands of other LGBTQ young people on http://www.trevorspace.org/topics.cfm?src=1 .
If you need immediate support, please call 911 or visit a hospital to get help from a mental health professional. Please continue to reach out for support. Although you may feel like it sometimes, remember, you are not alone.


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Other projects made by Mkaryl Design:
See All Projects by Mkaryl Design »Offer some kudos...
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Here are some details about my project: | |
Category | Knitting |
Type | Accessory |
Sizing | Women |
Style | Traditional, Casual, Whimsical, Funky, Mod, Classic, Cute |
What was your source for this knitting project?
Online Photo or Website
Name of website or photo
Seven Stitch Headband
What materials did you use? I made the original headband using Wisdom Yarns Poems Puzzle -- an I-cord yarn in beautiful colors worked on a #19 needle. I have made subsequent headbands using stash yarns.
What are you most proud of? The rave reviews I have received when wearing the headband out! And the fact that most knitters will be able to complete a headband in less than an hour, making it quick and easy to create some lovely gifts for others to enjoy.


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Cho Oyu Climb with International Mountain Guides
Good News! Chinese have begun issuing permits for expeditions to the North side of Cho Oyu and Everest. Hopefully future expedition teams to Tibet do not experience the intermittent permit issues that we have had over the past few years. Of the 24 expeditions that we scheduled to Cho Oyu since 1995, only twice have we had to cancel due to permit issues. If this ever occurs again, we offer climbers the option to:
- Get a full refund
- Go to a different mountain if we change the itinerary
- Keep the money on hold with IMG and apply to another climb
Eric Simonson
Thanks for your interest in our Cho Oyu Expedition climb. Cho Oyu is the 6th highest mountain in the world (8,201m) and is a classic Himalayan climb. Since 1995 we have seen 222 climbers reach the summit of Cho Oyu with our IMG teams on the 25 expeditions (23 successful) we have conducted via the original 1954 route from Tibet. We're proud to have the best climbing record on the mountain. Our programs are recognized worldwide as well organized with first-rate logistics and experienced leaders, conducted under the direction of legendary climber and expedition leader, Eric Simonson.
IMG was one of the very first 8000m Himalayan operators to run Tibet Everest and Cho Oyu expeditions, and 2014 marks 24 years of running expeditions in Tibet.
For Trekkers who wish to accompany the expedition, please contact Eric Simonson for more information. We have a limited number of spaces for trekkers on this team. If you are strong, it is possible to hike all the way to Camp 1 which is OVER 20,000 feet (as a day trip, but not spend the night there). If you are looking for a challenging trek, this is it!
Personal Sherpa and Extra Oxygen Option
In addition to the all the benefits and Sherpa support that goes with our Classic Cho Oyu program, we will also assign exclusively to you one of our very best Sherpas, who has summitted Cho Oyu and Everest many times, been through the Khumbu Sherpa climbing school, and who speaks English well. As a small two-person team, you will be able to take advantage of the "best of both worlds" with all the "horsepower" of the main IMG team at their disposal, but also having the additional flexibility of your own dedicated climbing partner. Your personal Sherpa will also be available to help carry your personal gear to the higher camps. In addition, we will provide extra oxygen so you can start using oxygen at Camp 2.
Note on Dates
Dates are listed starting with the arrival day to Kathmandu to the arrival day back to Kathmandu at the end of the trip. The ending date for the CHO OYU CLIMB is flexible, depending on weather and conditions. It would be normal to add at least 7 extra contingency days on the itinerary for the climb. If necessary, climbers will change their departure flights from Kathmandu when they know exactly when the expedition is going to end.
Spring vs. Autumn
Spring has less snow and avalanche danger, but has more ice and is more technical. The autumn can be good, but if you get a big snow dump (more likely in the autumn than spring,) you could be out of luck.
Spring starts out cold and windy, and gets better. Autumn starts out warm and wet, hopefully has a good stretch, then gets cold and windy later in the season. We try to climb in the spring during mid-May, when the weather starts to improve, and in the autumn during late September/early October before it gets too cold, and there are big snow storms.
Generally speaking, Everest is good in the Spring, less reliable in the Autumn. Cho Oyu is good both Spring and Autumn. There are probably more expeditions on Cho Oyu in the Autumn, since many companies are on Everest in the Spring.
International Mountain Guides (IMG)
IMG is the oldest and most respected high-altitude climbing service in the world and its three principals, Eric Simonson, Phil Ershler, and George Dunn, have led and organized hundreds of expeditions worldwide. Each is an AMGA Certified Alpine Guide with Himalayan expedition experience including Everest, K2, Kangchenjunga, Shishapangma, and Cho Oyu. IMG's Himalayan mountaineering programs are organized and directed by Eric Simonson, one of the world's premiere expedition organizers. Under his direction IMG has conducted over 40 Himalayan expeditions. His teams include a group of professionals and Sherpas who are the best in the business. Since 1990, over 600 IMG team members have summited the world's classic 8,000-meter peaks, including Everest, Lhotse, Cho Oyu and Shishapangma.


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Discover the 10 Albums that changed Sebastian Bach's life July 2, 2012 | Goldmine staff | 1 Former Skid Row vocalist Sebastian Bach was raised on some of the best hard rock and heavy metal ever — and it began with Christmas gifts from his father. ►
Sebastian Bach signs with Frontiers Records February 14, 2011 | princep | 0 Italian label Frontiers Records announced the signing of Sebastian Bach to an exclusive worldwide, multi-album recording contract. ►
Dio colleagues weigh in on his legacy May 18, 2010 | princep | 0 A bunch of Ronnie James Dio's colleagues shared their thoughts with Goldmine over the passing of the metal legend ►
Gary Moore has got it bad for the blues October 23, 2008 | Goldmine Staff | 0 Gary Moore, the ex-Thin Lizzy guitarist, delivers another fire-and-brimstone epistle of hard-rocking blues on his latest LP. ►
Tour News: Sebastian Bach is on the road July 31, 2008 | Goldmine Staff | 0 Former Skid Row singer Sebastian Bach is out on a solo tour. ►


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February 06, 2004 |
Publication Date: Friday, February 06, 2004 More than a widow
Palo Alto native Russell Rickford returns home to pen biography of Betty Shabazz
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Copyright © 2004 Embarcadero Publishing Company. All rights reserved. Reproduction or online links to anything other than the home page without permission is strictly prohibited. |